Chasing dreams

Not getting enough sleep over a long period of time can have many consequences, both psychological and physiological, according to Professor Richard Costello, a respiratory consultant with the Royal College of Surgeons and the insomnia clinic at the Bons Secours Hospital, Dublin. He is also a clinician scientist with the Health Research Board.

“The effects of lack of sleep range from psycho-social ones, like low-grade anxiety and depression, poor memory and poor social interaction,” he says. “Then there are also the physiological ones, like weight gain or inability to lose weight, impaired handling of blood sugars and increased risk of propensity to diabetes and hypertension (high blood pressure).”

He is talking about a situation where there is a chronic low grade attainment of sufficient sleep on a daily basis over an extended period of time – a person who has a long commute to work, for example.

“What’s happening insidiously is that they might be getting 10-20% less sleep in the weekday and that might be going on for years and that’s why the sleep disorder has started to come into play.

“Short-term sleep loss doesn’t generally affect you as you catch up, but a small deficit over the long term can have wider consequences,” he says.

There are three health conditions relevant to sleep deficit. These are sleep apnoea, restless legs and chronic insomnia.

SLEEP APNOEA

Weight gain is often involved here, he states.

“When people, particularly men, gain weight, the weight is sometimes distributed around the neck and the tongue.

“This means that the tongue becomes relatively heavy and closes over when you breathe in, particularly when you are asleep.”

This interrupts the flow of air into the lungs and the brain begins to perceive that interruption in flow as a sort of threat.

“It thinks it is being strangled. This then arouses the system to move the tongue out of the way and that disturbs sleep, so the person has a disrupted sleep but isn’t necessarily aware of this.

“All they’re doing is snoring and stopping breathing and re-starting, but they wake up feeling very unrefreshed, feeling almost hungover in the morning.”

RESTLESS LEGS

The condition known as restless legs is another important disturber of sleep, but one that often doesn’t get attention as a cause.

“It’s a condition where people feel that their legs are jumpy. Just as they are falling asleep their legs become irritable, uncomfortable or twitchy and they have to move them. This stops them getting a good night’s sleep.

“It’s like a mobile phone going off just as you’re dropping off.”

Restless legs can happen to people sitting in a car as a passenger for a long period of time – their legs get jumpy and are constantly moving.

“As with sleep apnoea this disturbs their partner’s night’s sleep as well. For some people, sleep apnoea can also be related to a deficiency in iron.”

INSOMNIA

Chronic insomnia is a condition where the person has difficulty either initiating or maintaining sleep.

“Sometimes psychological stress or something acute happens to the person and they find their sleep disturbed. This then becomes a habit, though not a deliberate one. It’s a feature where the brain expects to wake up.”

He points out that, as humans, we have a tendency in our brain for sleep patterns to develop by the time we are teenagers.

“By then, you have this very deeply-ingrained pattern of sleep. Some people need seven hours, some people need nine, some go to bed early and get up early, some go to bed late and so on – there are ‘larks’ and ‘owls’. Most of us need seven or eight hours sleep, but it’s hugely varied.

“This is the long-term schedule that the body has. It’s like how some people go to the bathroom more than others. Everyone has their pattern and it differs for every individual.”

Disruption to the pattern can come if it is regularly upset, however.

“Your (sleep) pattern can be overridden sometimes, though. For example, if you have to get up very early in the morning to get a taxi, you often find that you wake a few minutes in advance of the alarm clock.

“That’s a mechanism that illustrates that the brain, while it can normally initiate sleep and finish sleep at its own time, it can also monitor the situation to change that. If that process of monitoring and maybe overriding the natural system becomes a pattern, then you develop insomnia.

“That usually develops with somebody thinking about their situation. Equally, it could also be after worrying about an event for a while. The unusual then becomes the normal situation for the individual and disrupts their pattern of sleep. That’s what insomnia is.”

TREATMENT OF SLEEP DISORDERS

But when should a person seek referral to a specialist?

This depends on their threshold, Professor Costello says.

“Every case is different. It’s when they begin to think of what’s happening as a problem. Perhaps the person’s spouse is saying that the snoring is a problem, not just an irritation. It depends on the individual.”

People come along saying they are tired rather than that they haven’t slept, in his experience.

“It’s the consequences of it, rather than the physical problem that dominate the issue and what they say.”

Finding the cause is the first step

“We listen to their story, establish what their driver is, ie what they would like to get solved. Then we usually do a sleep study so that we can monitor and identify what’s going on.”

This involves the person staying overnight in a sleep clinic. For that night they are wired up to monitors.

“The overnight tests will indicate whether they are stopping breathing, which would indicate sleep apnoea, or if they have restless legs and some other things.”

TREATMENT FOR SLEEP APNOEA

Three or four different treatment approaches can help if you have sleep apnoea, says Professor Costello.

“Sometimes weight loss helps, but that can be difficult for some people. A special mask can help others. This blows air in so instead of sucking air in, which caused the throat to close, air is instead blown in through the nose and mouth to open up the airway. This can be very effective.

“Some people get a gum shield or mouth guard that brings the jaw forward and stops the tongue collapsing against the back of the throat.”

TREATMENT FOR RESTLESS LEGS

The condition known as restless legs can be treated by iron replacement or by other specific prescribed medications.

TREATMENT FOR INSOMNIA

Medication generally isn’t the answer for insomnia, says Professor Costello.

“It’s often best treated with a change in restoring the pattern of sleep back to the person’s original dominant, long-established rhythm.

“The new breakthrough rhythm that has started has to be addressed. You re-establish the old rhythm paradoxically with sleep deprivation – not extremes of deprivation, but you try and force the insomnia away by restricting sleep to break the newly-established bad habit.”

Getting the help of a sleep therapist with this can be important and sleep therapy, or what’s called behavioural therapy with biofeedback, is the modern treatment for insomnia.

“Like a physiotherapist would plan exercises to improve your mobility over time, the sleep therapist will help you re-establish you old sleep patterns.

“The person wears a wristband monitor that will indicate how well they’ve done with sleep restriction and how much sleep they’ve had, and so on.”

He points out that it is in some way similar to CBT or Cognitive Behavioural Therapy, but biofeedback is a better way to describe it.

“Technically it is CBT, because you’re using understanding as a behavioural technique, but it’s not the same CBT as you would use for someone with mild anxiety or depression.” CL

Sleep deprivation – more on how it can affect you

Sleep deprivation can also affect your overall health, according to Mental Health Ireland.

Being tired can affect your ability to think clearly, react quickly and form memories.

It could lead to poor decision-making, risk taking and accidents.

Sleep deprivation can also affect your mood, which could lead to anxiety, depression or relationship problems.

In relation to physical health, not getting enough sleep makes you more at risk of high blood pressure, heart disease, stroke, kidney disease, obesity and type II diabetes.

Adults and children not getting enough sleep can mean that they don’t get enough of the hormones that help them build muscle mass, fight infections and repair cells.

Alcohol also has a bigger impact if you are sleep-deprived.

Mental health Ireland’s tips for helping yourself sleep better

Mental Health Ireland points out that sleep is not just ‘time out’ from our busy routine. Most of us need to sleep well to help our bodies recover from the day and to allow healing to take place.

Sleep problems can be a symptom of other conditions, such as a problem with your thyroid gland or depression, so it’s worth seeing your GP if your sleeping problems continue.

Here are some tips to combat sleep problems: